Complex Regional Pain Syndrome following Spine Surgery: Clinical and Prognostic ImplicationsWolter T.a · Knöller S.M.a, b · Rommel O.c
aInterdisciplinary Pain Center and bDepartment of Orthopaedic and Trauma Surgery, University Hospital Freiburg, Freiburg, and cRommel Klinik, Bad Wildbad, Germany
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: Complex regional pain syndrome (CRPS) has been reported following spinal surgery, but its frequency after spinal surgery is unknown. The aim of this study was to determine the frequency of spinal surgery preceding CRPS and to examine these patients regarding the course of the disease and prognostic factors. Methods: We examined 35 CRPS patients regarding the symptoms and signs of CRPS, the type of CRPS (I or II), the origin and grade of the disease, the type of surgeries prior to CRPS onset, the course of the disease, and the therapies following diagnosis of CRPS. Results: In 6 patients, CRPS began during the postoperative course (lumbar spine surgery, n = 5; cervical spine surgery, n = 1). Four of these patients suffered from CRPS II. The course of the disease in the 6 patients was not different from that of patients with CRPS of other origins. First symptoms of CRPS could be observed 1–14 days after surgery. Conclusions: CRPS is a rare complication after spinal surgery, but spinal surgery precedes the onset of CRPS of the lower limb in almost one-third of the cases. The first typical symptoms of CRPS emerge within 2 weeks after spinal surgery.
© 2012 S. Karger AG, Basel
- Birklein F: Complex regional pain syndrome. J Neurol 2005b;252:131–138.
- Birklein F, Schmelz M, Schifter S, Weber M: The important role of neuropeptides in complex regional pain syndrome. Neurology 2001;57:2179–2184.
- Köck FX, Borisch N, Koester B, Grifka J: Complex regional pain syndrome type I (CRPS I). Pathophysiology, diagnostics, and therapy (in German). Orthopade 2003;32:418–431.
- Schurmann M, Gradl G, Zaspel J, Kayser M, Lohr P, Andress HJ: Peripheral sympathetic function as a predictor of complex regional pain syndrome type I (CRPS I) in patients with radial fracture. Auton Neurosci 2000;86:127–134.
- Birklein F, Weber M, Ernst M, Riedl B, Neundorfer B, Handwerker HO: Experimental tissue acidosis leads to increased pain in complex regional pain syndrome (CRPS). Pain 2000;87:227–234.
- Gradl G, Schurmann M: Sympathetic dysfunction as a temporary phenomenon in acute posttraumatic CRPS I. Clin Auton Res 2005;15:29–34.
- Rommel O, Gehling M, Dertwinkel R, Witscher K, Zenz M, Malin JP, et al: Hemisensory impairment in patients with complex regional pain syndrome. Pain 1999;80:95–101.
- Rommel O, Malin JP, Zenz M, Janig W: Quantitative sensory testing, neurophysiological and psychological examination in patients with complex regional pain syndrome and hemisensory deficits. Pain 2001;93:279–293.
- Wasner G, Heckmann K, Maier C, Baron R: Vascular abnormalities in acute reflex sympathetic dystrophy (CRPS I): complete inhibition of sympathetic nerve activity with recovery. Arch Neurol 1999;56:613–620.
- Stanton-Hicks M, Janig W, Hassenbusch S, Haddox JD, Boas R, Wilson P: Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain 1995;63:127–133.
- Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, et al: External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. International Association for the Study of Pain. Pain 1999;81:147–154.
- Harden RN, Bruehl S, Galer BS, Saltz S, Bertram M, Backonja M, et al: Complex regional pain syndrome: are the IASP diagnostic criteria valid and sufficiently comprehensive? Pain 1999;83:211–219.
Harden RN, Bruehl S: Diagnostic criteria: the statistical derivation of four criterion factors; in Wilson P, Stanton-Hicks M, Harden RN (eds): CRPS: Current Diagnosis and Therapy. Seattle, IASP Press, 2005.
- Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR: Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 2007;8:326–331.
- Harden RN, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C, et al: Validation of proposed diagnostic criteria (the ‘Budapest criteria’) for complex regional pain syndrome. Pain 2010;150:268–274.
- Schurmann M, Gradl G, Rommel O: Early diagnosis in post-traumatic complex regional pain syndrome. Orthopedics 2007;30:450–456.
Merskey H, Bogduk N: Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms, ed 2. Task Force on Taxonomy of the International Association for the Study of Pain. Seattle, IASP Press, 1994:39–43.
- Knoeller SM, Ehmer M, Kleinmann B, Wolter T: CRPS I following artificial disc surgery: case report and review of the literature. Eur Spine J 2011(suppl 2):S278–S283.
- Sachs BL, Zindrick MR, Beasley RD: Reflex sympathetic dystrophy after operative procedures on the lumbar spine. J Bone Joint Surg Am 1993;75:721–725.
- de Weerdt CJ, Journee HL, Hogenesch RI, Beks JW: Sympathetic dysfunction in patients with persistent pain after prolapsed disc surgery. A thermographic study. Acta Neurochir (Wien) 1987;89:34–36.
- Bernini PM, Simeone FA: Reflex sympathetic dystrophy associated with low lumbar disc herniation. Spine 1981;6:180–184.
- Condon F, Kenny PJ, Griffin JG, O’Rourke K: Reflex sympathetic dystrophy associated with extraforaminal disc herniation at the L5-S1 level. J Spinal Disord 1998;11:448–451.
- Adachi M, Tamaoka A, Harada K, Mizusawa H, Shoji S: Reflex sympathetic dystrophy secondary to lumbar disk herniation (in Japanese). Rinsho Shinkeigaku 1994;34:61–64.
- Perrot S, Ziza JM, Khalifa P, Chazerain P, Campagne JP, Le Quintrec JL: Persistent pain following discal sciatica: reflex sympathetic dystrophy, an unusual complication to be examined. Apropos of 4 cases (in French). Rev Rhum Mal Osteoartic 1992;59:745–747.
- Ballard EM, Ellenberg M, Chodoroff G: Reflex sympathetic dystrophy syndrome secondary to L5 radiculopathy. Arch Phys Med Rehabil 1991;72:595–597.
- Weisz GM, Houang M, Bogduk N: Complex regional pain syndrome associated with cervical disc protrusion and foraminotomy. Pain Med 2010;11:1348–1351.
- Lee KS, Su YF, Lieu AS, Chuang CL, Hwang SL, Howng SL, et al: The outcome of percutaneous computed tomography-guided chemical lumbar sympathectomy for patients with causalgia after lumbar discectomy. Surg Neurol 2008;69:274–279; discussion 279–280.
- North RB, Kidd DH, Farrokhi F, Piantadosi SA: Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery 2005;56:98–106, discussion 106–107.
- Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, et al: Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 2007;132:179–188.
- Kemler MA, Barendse GA, van Kleef M, de Vet HC, Rijks CP, Furnee CA, et al: Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000;343:618–624.
- Taylor RS: Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome: results of a systematic review and meta-analysis. J Pain Symptom Manage 2006;31(4 suppl):S13–S19.
- AbuRahma AF, Thaxton L, Robinson PA: Lumbar sympathectomy for causalgia secondary to lumbar laminectomy. Am J Surg 1996;171:423–426.
Plancarte R, Calvillo O: Complex regional pain syndrome type 2 (causalgia) after automated laser discectomy. A case report. Spine (Phila Pa 1976) 1997;22:459–461, discussion 461–462.
- Mockus MB, Rutherford RB, Rosales C, Pearce WH: Sympathectomy for causalgia. Patient selection and long-term results. Arch Surg 1987;122:668–672.
- Carlson DH, Simon H, Wegner W: Bone scanning and diagnosis of reflex sympathetic dystrophy secondary to herniated lumbar disks. Neurology 1977;27:791–793.
- Chodoroff B, Ball RD: Lumbosacral radiculopathy, reflex sympathetic dystrophy and tarsal tunnel syndrome: an unusual presentation. Arch Phys Med Rehabil 1985;66:185–187.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.